As Italy's coronavirus death toll surpasses China's, hospitals are continuing to see a surge of severe patients requiring intensive care. In just two weeks, Italy's intensive care capacity grew by an impressive 15%, which corresponds to 800 additional beds for COVID-19 patients in serious need. That's compared to a growth of just 350 beds nationally over the entire last decade. How did they do it?
It took a multi-pronged response, not just from the health care system but the entire community. We recently spoke with Stefano Reggiani, Medical Director of Hesperia Hospital, to learn more.
Dr Reggiani admits he underestimated the extent of the crisis until just 20 days ago, when the number of patients admitted to his hospital was exponentially increasing and the severity of their respiratory complications wasn't decreasing but getting worse every day. Dr Reggiani's hospital is in Emilia-Romagna, the second-most hit region in Italy (after Lombardia), with more than 5,200 confirmed coronavirus cases as of March 19.
He commented that while under normal circumstances a patient is kept on ventilation support for a maximum of 7-10 days, COVID-19 patients require support for weeks, severely cutting the availability of ventilators and ICU beds.
"The only intensive care beds available are those left vacant by patients who pass away," he told us. Italy's northern regions have exhausted ICU capacity, while nationally, the intensive care capacity rate hovers around 80% thanks to drastic efforts to grow intensive care availability. Hospitals around the world are trying to prepare for this reality.
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What can the rest of the world learn from the Italian experience?
In late February 2020, the Italian government issued a mandate to regional health authorities to increase ICU capacity by 50%, and to double the number of pneumonia and allergology beds in a matter of weeks.
This mandate was the start of an unprecedented transformation at Italian hospitals, whose leaders undertook five strategies to expand capacity in the pandemic.
- Halt elective surgeries to transform operating rooms into ICUs. Postponing non-emergent procedures freed up space and released staff from pre- and post-op responsibilities. Additionally, operating rooms were already equipped with the necessary technology and setting, allowing for COVID-19 patients to be put on ventilation.
- Upgrade semi-intensive care beds into full intensive care. While semi-beds are usually less equipped, they do come with ventilators. Semi-ICU beds were immediately upgraded to full beds for coronavirus patients.
- Recruit specialists in training and retired. Italian hospitals recruited clinicians specialised not only in respiratory care, but also in emergency care and anaesthesiology if they were completing their third year of training or if they had recently retired.
- Quickly wean recuperating patients off ventilators. Making ICU beds available as soon as safely possible was just as important as growing the number of total beds. Italian hospitals put strict protocols into place to wean patients off where possible.
- Designate COVID-dedicated hospitals for low-risk or recovering patients. Increasingly, health authorities are designating some providers as “COVID hospitals” where patients who don’t need ventilation support can be transferred to for recovery.
Even in the face of all these heroic and impressive efforts, the number of ICU beds, trained staff, and equipment hasn't been enough to meet the continuously growing demand.
When that became apparent, the wider community stepped in. From politician Silvio Berlusconi's €10M donation to build a makeshift hospital in Milan adding 400 ICU beds, to celebrities Fedez and Chiara Ferragni fundraising €4M (the largest GoFundMe campaign in European history), the Italian elite have mobilised their vast networks and deep pockets. Dr Reggiani says he thinks this week will be the inflexion point for COVID-19 in Italy, hoping that the worst is almost over.
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Each of these scenarios—which cover impact on capacity, clinicians and staff, and the broader ecosystem—includes a set of questions that leaders can use to engage preparedness planning leaders, taskforces, partners, and other executives to identify potential gaps in strategy.